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Corticosteroids for patients with vestibular neuritis: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department

Corticosteroids for patients with vestibular neuritis: An evidence synthesis for guidelines for... INTRODUCTIONVestibular neuritis (VN) is an acute peripheral vestibulopathy presumably caused by a viral or postviral inflammation of the vestibular component of the eighth cranial nerve that presents as an acute vestibular syndrome.1 When the cochlear component is also involved, it is called labyrinthitis and hearing is also affected in those cases. Posterior circulation stroke, adverse medication effects, and infections can present similarly, but VN is the most common etiology of acute vestibular syndrome persisting for more than 24 h and presenting to the emergency department (ED).2 Clinically, the most common presentation of VN is a sudden onset of sustained vertigo and imbalance accompanied by acute spontaneous unidirectional horizontal nystagmus with a slight torsional component that is suppressed with visual fixation. These patients have a positive head impulse test (presence of a corrective saccade), no skew deviation, and gait instability but usually with preserved ability to ambulate unassisted.3,4 Autonomic features such as nausea and vomiting may also be present.Leaving aside the diagnostic dilemma of differentiating VN from posterior stroke among patients presenting with acute vestibular syndrome,5,6 those with a presumed diagnosis of VN require acute disease‐specific treatment and a short course of corticosteroids is among the management strategies considered by specialists.7 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Academic Emergency Medicine Wiley

Corticosteroids for patients with vestibular neuritis: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department

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References (49)

Publisher
Wiley
Copyright
Copyright © 2023 Society for Academic Emergency Medicine
ISSN
1069-6563
eISSN
1553-2712
DOI
10.1111/acem.14583
Publisher site
See Article on Publisher Site

Abstract

INTRODUCTIONVestibular neuritis (VN) is an acute peripheral vestibulopathy presumably caused by a viral or postviral inflammation of the vestibular component of the eighth cranial nerve that presents as an acute vestibular syndrome.1 When the cochlear component is also involved, it is called labyrinthitis and hearing is also affected in those cases. Posterior circulation stroke, adverse medication effects, and infections can present similarly, but VN is the most common etiology of acute vestibular syndrome persisting for more than 24 h and presenting to the emergency department (ED).2 Clinically, the most common presentation of VN is a sudden onset of sustained vertigo and imbalance accompanied by acute spontaneous unidirectional horizontal nystagmus with a slight torsional component that is suppressed with visual fixation. These patients have a positive head impulse test (presence of a corrective saccade), no skew deviation, and gait instability but usually with preserved ability to ambulate unassisted.3,4 Autonomic features such as nausea and vomiting may also be present.Leaving aside the diagnostic dilemma of differentiating VN from posterior stroke among patients presenting with acute vestibular syndrome,5,6 those with a presumed diagnosis of VN require acute disease‐specific treatment and a short course of corticosteroids is among the management strategies considered by specialists.7

Journal

Academic Emergency Medicine – Wiley

Published: May 1, 2023

Keywords: Caloric test; corticosteroids; dexamethasone; dizziness; head impulse test; methylprednisolone; nausea; Steroid; vertigo; vestibular neuritis; vestibular rehabilitation

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